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Reconstitution & Dilution

Many injectable drugs are supplied as a powder because they are unstable in solution. Reconstitution adds a stated volume of a stated diluent — usually sterile water or normal saline — to produce a solution of known strength. The vial label specifies both, and it also states the final concentration, which is not simply the drug divided by the diluent: the powder itself takes up space, so adding 1.8 mL may produce 2 mL of solution. That final concentration is the number that belongs in the dose formula, and once a multi-dose vial is reconstituted it carries a new, shorter expiry.

The label states the diluent and how much to add Hallmark
The label states the final concentration Hallmark
use this in the dose formula
Final volume is larger than the diluent added Hallmark
the powder displaces volume
Reconstitution makes a solution from a powder
Dilution spreads an existing solution into more volume
A reconstituted vial expires sooner than an unopened one Hallmark

Worked example: label says add 1.8 mL, yields 2 mL at 250 mg/mL; order is 500 mg

  1. Read the labeldiluent, amount, final concentration
  2. Add 1.8 mL diluentthe stated amount, not a guess
  3. Roll to dissolvedo not shake
  4. Use 250 mg/mLthe label's concentration
  5. Draw 2 mL500 / 250 = 2 mL
Check the vial for particles or cloudiness Hallmark
Check the reconstituted expiry before every subsequent dose Hallmark
Store as the label directs after reconstitution
many require refrigeration
Discard an unlabelled reconstituted vial
Follow the pharmacy's mixing instructions exactly Hallmark
Refrigerate a reconstituted suspension if told to
Shake or roll the bottle as directed before each dose Hallmark
Discard the bottle on the date the pharmacy wrote on it
Report Nowescalate immediately
A reconstituted vial with no concentration written on it Hallmark
Particles, cloudiness or discolouration after mixing Hallmark
A dose calculated from the diluent volume instead of the concentration Hallmark
A vial past its reconstituted expiry
The wrong diluent used
some drugs are incompatible with saline or with water

Clinical Pearl

The label tells you the diluent and the final concentration. Use its concentration in the formula — never the volume you added.

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